This is a great New York Times magazine article about healthcare. Well, really it’s an article about one man (Brent James) who is trying to change health care by trying to standardize doctors approaches to certain health issues based on evidence. Apparently doctors don’t particularly care to be ‘standardized’ and his approach actually loses hospitals money but, patient outcomes are significantly better and his approaches eliminate waste in the form of needless tests and procedures.

Dr. James is aiming to take a bit of the ‘intuition’ out of medicine and replace it with evidence-based practice and his successes have been impressive. However, with evidenced-based practice comes protocols- and many doctors enjoy the autonomy of acting without specific rules which is why many people think that his approach will never catch on. Too bad, because he really is on to something.

One part of the article talks about how Intermountain Hospital (where his projects are taking place) has reduced the number of perterm deliveries and the number of babies who spend time in their neonatal-intensive-care unit. They did this by creating a committee back in 1998 whose prime success has been to reduce the number of elective inductions (births that are induced without medical reason). They felt that the risks to neonates outweighed the convenience that elective induction afforded doctors and patients, plus induced labors were generally longer and resulted in more C-sections. Since 1999 ACOG has recommended that no elective inductions be performed before 39 weeks, yet around the country roughly 30% of inductions are done before 39 weeks. Back in 1998, Intermountain shared that figure of around 30% early inductions. When the committee adopted the protocol, the rate began to fall and now hovers around less than 2%. YAY! The number of newborns with respiratory problems has also dropped as did the C-section rate of those doctors that complied to the protocol.

This was my favorite part: “One hospital in southwest Utah has gone so far as to allow nurses to refuse a doctor’s early induction orders unless the medical director gives permission” (!)

As I was reading this article, it really made me pause and think about autonomy and protocols. I basically quit nursing because I felt I didn’t have any autonomy. Nursing school teaches you to think critically and independently, yet on the job we are expected to follow a doctor’s order with no questions asked. We are expected to adhere to a very clear set of standards and protocols for each duty we perform. The doctor on the other hand is trained to ‘follow intuition’ and is given license to treat in any way he or she sees fit, almost balking at rules or protocol irregardless of the evidence. It makes me think that if we could move to a model of evidence-based practice, doctors and nurses would be able to work more as a team, nurses would be able to hold doctors accountable for crappy practices and it might result in happier nurses. I would even argue that a move to evidence-based medicine could even help solve the nursing shortage. Most smart women these days don’t want to be nurses- mainly because it’s hard work in a thankless environment. But if a nurse could be an important part of a medical TEAM whose goal was to provide good outcomes for patients, then maybe more people would be attracted to the profession.